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Affordable Care Act (ACA)

The new health care law offers a host of coverage changes and opportunities beginning in 2014. Blue Cross and Blue Shield of Texas (BCBSTX) is committed to implementing coverage changes to comply with ACA requirements and to better meet the needs and expectations of you and your patients.

This section offers updated information and resources to keep you informed of the issues potentially affecting the administrative and patient care aspects of your practice. We invite you to refer back to this page often for ongoing information on ACA provisions.

Initial provisions of the Affordable Care Act (ACA) were implemented in March 2010. Additional provisions, including the individual mandate to have health coverage beginning January 1, 2014, will continue to be enacted in subsequent phases through 2018. Learn more.

Under the multiphase initiative known as Administrative Simplification, health plans are required to implement new operating rules to promote greater uniformity in the exchange of electronic health care information. Blue Cross and Blue Shield of Texas (BCBSTX) implemented operating rules for the first and second phases in January 2013. System changes are currently in progress for the next phase. Learn more.

As a result of the new law, individuals and families will have more options for managing their health care needs with expanded coverage for women, children and individuals with pre-existing conditions. Other provisions offer greater access to preventive care services with no cost sharing, and guarantees coverage of essential health benefits in our individual and small group insurance products. Learn more.

Risk Adjustment identifies the differences in health care risk among specific patients. This Risk Adjustment methodology serves as a mechanism to convey the illness burden a provider is managing within its patient population, thus allowing for fair comparison of quality outcomes and cost performance. Risk Adjustment, along with Reinsurance and Risk Corridors, helps ensure that payers and providers are able to focus on quality and service. Learn more.